Domhnall MacAuley: International Quality Forum, day 1

Domhnall MacauleyOn welcoming 3300 delegates from 80 countries to the International Quality Forum in London, home of the BMJ, Fiona Godlee (editor in chief, BMJ) asked us to remember the recent marathon trauma at the home of Institute of Healthcare Improvement (IHI) in Boston. All the more poignant as we congregated at Excel, the registration centre for next Sunday’s London marathon. Maureen Bisognano (IHI), in her opening  address, applauded the response of the medical services in Boston and how it highlighted the key attributes of an exemplary health service; reliability, resilience, and empathy. Maureen had some serious questions—when we look at data, are we looking back or are we using the data to predict and prevent problems for the future.  She asked us not to think in terms of  “what’s the matter medicine, but what matters to you.” Medicine tends to focus on efficiency and effectiveness, and we need to think more about empathy. Patient engagement, she said, is the next blockbuster drug.

When Robert Francis QC and Don Berwick were asked for their hopes and aspirations for this 18th Quality Forum, they reflected on the difficulties faced by health services in both the UK and US; the uncertainties, fiscal pressures, political influence, and understanding what can go wrong. Most important, however, was not so much listening to the content of the academic sessions, but bringing the practical messages into everyday patient care.

Mats Bojestig, in a session on transforming care for people with cancer, pointed out that we often think of healthcare as a pyramid but it is more like a circus—trying to juggle all the different parts. He told us about their vision in Jonkoping—“I will get the care and support I need when I need it.” He encouraged us to think in terms of promises and not goals. This stimulated a fascinating discussion about the meaning of promises, goals, and guarantees in healthcare. But, ultimately, organisations write goals and make promises that can be difficult for individual clinicians or groups to fulfil.

Patients don’t always think the way clinicians think that patients think. Ann Driver and Celia Ingham Clarke described how they changed the pattern of breast cancer surgery in England.  Cancer care specialists didn’t believe a short stay was fair for breast surgery patients. But, patients didn’t think like that—they want to get back to normal as soon as possible—they want to go home. The aim was—day surgery, one night stay. Now 84% of patients are on that pathway and the overall average length of stay is less than one day.

Natalie Armstrong and Ian Woolhouse told us about the lung cancer outcomes project where they used a randomised controlled trial, not in research, but in implementing best practice. It was successful not just in improving clinical management, but in patient experience. The intervention was based on the principles of the clinical community—peer influence to change behaviour and harness collective power. But, the key was supporting and sustaining the intervention.

Live interactive conferencing! Not only was the conference sold out, but it was broadcast to a vast live virtual audience with conference centres in Japan, Singapore, Australia, and New Zealand. Each session had an “info DJ” who monitored the twitter feed and asked the questions put by this virtual audience.  Social media shrinking the world—and even enabling those present in the live audience, but too shy to ask their question. Amazing immediacy. Today’s blog seems snail paced in comparison.

Domhnall MacAuley is primary care editor, BMJ.